Provider Demographics
NPI:1881109916
Name:KEENER, CYNTHIA LYNN (MED LPCC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LYNN
Last Name:KEENER
Suffix:
Gender:F
Credentials:MED LPCC
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:LYNN
Other - Last Name:BROWN-KEENER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CT/CDCA
Mailing Address - Street 1:130 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:44851-1128
Mailing Address - Country:US
Mailing Address - Phone:419-706-2160
Mailing Address - Fax:
Practice Address - Street 1:725 WESSOR AVE
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-9417
Practice Address - Country:US
Practice Address - Phone:567-805-8817
Practice Address - Fax:877-631-9208
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1700268-TRNE101Y00000X
OHCDCA.163229101YA0400X
OHC.1801034101YP2500X
OHE2202802101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0283292Medicaid